title: Predicting laryngeal edema in intubated patients by portable intensive care unit ultrasound.
abstract: OBJECTIVE
  The purpose of this study is to determine the diagnostic accuracy of portable ultrasound for detection of laryngeal edema (LE) in intubated patients.
  
  
  METHODS
  We conducted a prospective, observational study from December 2010 to September 2011. We measured air column width differences (ACWD) in planned extubation patients admitted in intensive care unit by ultrasound. The primary outcome was the diagnostic accuracy of ACWD to predict the presence of LE.
  
  
  RESULTS
  A total of 101 patients were enrolled. The prevalence of LE was 16.8%. Baseline characteristics were similar between intubated patients with and without LE. The mean difference of increasing of air column width in patients without LE was higher than in LE group (1.9 vs 1.08 mm, P<.001). The sensitivity and specificity at ACWD higher or equal to 1.6 mm were 0.706 and 0.702, respectively. The positive predictive value and negative predictive value were 0.324 and 0.922, respectively. The area under the receiver operating characteristic curve of laryngeal ultrasound was 0.823 (95% confidence interval, 0.698-0.947) and that of cuff leak test was 0.840 (95% confidence interval, 0.715-0.964).
  
  
  CONCLUSIONS
  Portable intensive care unit ultrasound visualizing ACWD between predeflation and postdeflation cuff balloon is a promising objective tool, which aids in prediction of successful extubation regarding LE.
authors.affiliation: Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sutherasan_yuda@yahoo.com.
authors.forename: Yuda
authors.initials: Y
authors.lastname: Sutherasan
authors.forename: Pongdhep
authors.initials: P
authors.lastname: Theerawit
authors.forename: Tanasit
authors.initials: T
authors.lastname: Hongphanut
authors.forename: Charn
authors.initials: C
authors.lastname: Kiatboonsri
authors.forename: Sumalee
authors.initials: S
authors.lastname: Kiatboonsri
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007819:Laryngeal Edema / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: Cuff leak test; Laryngeal edema; Laryngeal ultrasonography; Post-extubation failure